P002 Combined radial and femoral approach in a patient with complex vascular anatomy and endovascular treatment of an unruptured aneurysm of the anterior communicating artery

<h3>Introduction</h3> Endovascular approach is often difficult and vascular anatomy can be challenging especially in elderly patients or when other vascular pathology is present. We present a 77y old female patient with unruptured aneurysm of the anterior communicating artery (AcomA) and an aneurysm of the aorta ascendens. Combined radial and femoral approach were used to achieve stability of the guiding catheter and further treat the aneurysm with coiling. <h3>Case Description</h3> A 77 year old female was diagnosed with an unruptured aneurysm of the AcomA. A bovine aortic arch was present and the left common carotid artery was difficult to catheterize using two or three co-axial system (figure 1). Due to a present dilation and aneurysm of the aorta ascendens and a bovine arch right sided radial approach or femoral approach both failed when used separately. A snare device (SD) was introduced through a 7fr radial sheath. An 8fr guiding catheter was introduced through an 8fr femoral sheath and caught inside the SD. Using this device for holding the guiding catheter a stable three coaxial configuration was achieved (figure 2). A 6fr catheter and 1.7 Fr microcatheeter with 0.14 inch micro guidewire were further introduced and an endovascular approach to the aneurysm was possible (figure 3). <h3>Results</h3> Combined radial and femoral approach may be used in difficult vascular anatomy. Using a snare device through a radial approach holding the guiding catheter may improve stability of the guiding catheter introduced by femoral approach.